PB 217: Prelabor Rupture of Membranes

Question 1

Definition: PROM

Answer 1

Prelabor rupture of membranes

Question 2

Etiology of PROM

Answer 2

Normal physiologic weakening of the membranes + shearing forces from uterine contractions

Risk factors: intra-amniotic infection, history of PROM, short cervical length, smoking, illicit drug use

Question 3

Among women with preterm PROM, clinically evident intraamniotic infection occurs in ____ of cases.

Postpartum infection occurs in approximately ____ of cases. The incidence of infection is higher at earlier gestational ages. Abruptio placentae complicates ____ of pregnancies with preterm PROM

Answer 3

15-35% / 15-25% / 2-5%

Question 4

Most common complication of preterm birth?

Answer 4

Respiratory distress >>>>> sepsis, IVH, necrotizing enterocolitis

Question 5

When performing SSE, what 4 things should one look for?

Answer 5

1. Cervicitis
2. Prolapse of the umbilical cord or fetal parts
3. Assess cervical dilatation and effacement
4. Obtain cultures as appropriate

Question 6

Normal pH of vaginal flora?

pH of amniotic fluid and what could distort Nitrazine test?

Answer 6

3. 8-4.5
4. 1-7.3

semen, BV, trich, blood, alkaline antiseptics, certain lubricants

Question 7

Usefulness of fetal fibronectin test?

Answer 7

Sensitive but non-specific test > if negative, intact membranes… if positive, not diagnostic of PROM (false positive rate 19-30%)

Question 8

Should tocolytic agents be considered for patients with preterm prelabor rupture of membranes?

Answer 8

The use of tocolytic therapy was associated with a longer latency period and a lower risk of delivery within 48 hours but also was associated with a higher risk of chorioamnionitis in pregnancies before 34 0/7 weeks of gestation.

Tocolytic therapy is not recommended in the setting of preterm PROM between 34 0/7 - 36 6/7 weeks of gestation.

Question 9

Should antenatal corticosteroids be administered to patients with PPROM?

Answer 9

A single course of corticosteroids is recommended for pregnant women between 24 0/7 - 33 6/7 weeks of gestation and may be considered for pregnant women who are at risk of preterm birth within 7 days, including for those with ruptured membranes, as early as 23 0/7 weeks of gestation

Question 10

Timing of rescue course of steroids?

Question 11

Should magnesium sulfate for fetal neuroprotection be administered to patients with preterm prelabor rupture of membranes?

Answer 11

Magnesium sulfate for fetal neuroprotection when birth is anticipated before 32 0/7 weeks of gestation reduces the risk of cerebral palsy in surviving infants

Question 12

Should antibiotics be administered to patients with preterm prelabor rupture of membranes?

Question 13

Latency antibiotic regimen

Answer 13

IV ampicillin (2 g every 6 hours) and erythromycin (250 mg every 6 hours) OR azithromycin (1 g every 24 hours) for 48 hours >> oral amoxicillin (250 mg every 8 hours) and erythromycin base (333 mg every 8 hours)

Question 14

How should a patient with preterm prelabor rupture of membranes and a cervical cerclage be treated?

Answer 14

A firm recommendation regarding whether a cerclage should be removed after preterm PROM cannot be made, and either removal or retention is reasonable.

Regardless, if a cerclage remains in place with preterm PROM, prolonged antibiotic prophylaxis beyond 7 days is not recommended.

Question 15

What is the optimal management of a patient with PPROM and HSV infection or HIV?